Pediatric venipuncture is one of the most stressful invasive procedures for children, often accompanied by intense pain, fear, and anxiety. This study aimed to compare the effects of two active distraction methods-bubble blowing and a material-free cognitive distraction/positive reinforcement technique-on pain, fear, and anxiety. This randomized controlled parallel-group trial was conducted between April and July 2025 in the pediatric venipuncture unit of a university hospital in western Türkiye. The sample comprised 207 children who met the inclusion criteria. The experimental arm included 135 children allocated to either Positive Reinforcement (n = 72) or Bubble Blowing (n = 63), and the control group consisted of 72 children who received standard care without any additional intervention during venipuncture. Data were collected using the Wong-Baker FACES Pain Rating Scale, the Child Fear and Anxiety Scale, and a Visual Analog Scale. Children's self-reported pain, fear, and anxiety scores were used as the primary outcome data. Parametric and nonparametric tests and effect sizes were used in the analyses. In the control group, postprocedural pain and anxiety scores increased significantly (p < .001), whereas the increase was attenuated in the bubble-blowing and positive reinforcement groups. Because baseline fear/anxiety scores differed between groups, ANCOVA was performed using preprocedural fear/anxiety scores as a covariate; the adjusted group effect remained statistically significant. In the positive reinforcement group, the increase in fear- anxiety scores was small and did not reach statistical significance. Bubble blowing was more effective than positive reinforcement in reducing pain. Both distraction techniques were associated with lower postprocedural pain and psychological distress scores compared with standard care. Bubble blowing showed a stronger effect on pain outcomes, whereas the positive reinforcement group showed only a small, statistically non-significant increase in fear/anxiety scores. These findings support the integration of simple, low-cost distraction strategies into pediatric nursing practice and skills training. The clinical trial registration number is NCT07249723. Registered 18 November 2025 - Retrospectively registered.
Spinal realignment surgery for adult spinal deformity improves radiographic alignment and patient-reported outcomes, but it remains unclear whether these gains translate into recovery of activity-level function and reduced fear of falling. Therefore, this study aims to determine whether (1) objective activity limitations and fear of falling change following ASD realignment surgery, and (2) whether trajectories differ across deformity subtypes. Fifty patients undergoing adult spinal deformity correction were assessed preoperatively, and at 6 months and 1 year postoperatively. Patient-reported outcomes were collected alongside objective functional impairment using the Function Assessment Scale for Spinal Deformity and fear of falling using the Falls Efficacy Scale-International. Patients were classified as decompensated sagittal malalignment, compensated sagittal malalignment, or coronal malalignment. Longitudinal changes and subgroup differences were analyzed using linear mixed-effects models. Patient-reported outcomes improved postoperatively, whereas functional impairment did not change over time (p = .618) and fear of falling remained high (p = .370). Decompensated sagittal malalignment was associated with lower functional performance (p = .011) and higher fear of falling (p = .010) compared with coronal malalignment. No subgroup-by-time interactions were observed for functional impairment (p = .988) or fear of falling (p = .251). After realignment surgery in adult spinal deformity, improvements in radiographic alignment and patient-reported outcomes did not translate into recovery of objective activity-level function or reduction of fear of falling within one year. These findings support the need for postoperative strategies targeting dynamic balance and persistent compensatory movement patterns.
Women who experience fear of birth during pregnancy are more likely to report negative birth experiences. Fear of birth and depressive symptoms may negatively influence women's birth experiences. Midwifery continuity of care (MCoC) models have been shown to improve satisfaction and may help mitigate fear and mental health challenges. To identify profiles of women based on birth experiences and emotional wellbeing after childbirth within MCoC models, and to examine associations with background characteristics, attitudes, and birth outcomes. A longitudinal cohort study was conducted in rural Sweden, including 378 women participating in MCoC models, with high priority on women with fear of birth. Data were collected via questionnaires in mid-pregnancy and two months postpartum. A k-means cluster analysis was performed using the Childbirth Experience Questionnaire (CEQ), Fear Of Birth Scale (FOBS), and Edinburgh Postnatal Depression Scale (EPDS). Three distinct profiles of women emerged based on the instruments included in the cluster analysis. The clusters differed in self-reported health, fear of birth, prenatal attitudes, continuity of care, and mode of birth. Women's attitudes and operative births were the strongest predictors of cluster membership. Continuity with a known midwife distinguished profiles characterised by elevated fear of birth and depressive symptoms. Women's birth experiences and emotional wellbeing cluster into distinct profiles shaped by psychological, relational, and contextual factors. Attitudes during pregnancy and mode of birth are key determinants, while continuity with a known midwife enhances the perception of professional support. Tailoring MCoC models to these profiles may promote more individualized, equitable, and positive care for diverse groups of women.
Fear and anxiety differ in their causes and psychophysiological responses to acute stress. While anxiety occurs before the threat, fear is activated in the immediate presence of the threat. In this study, virtual reality was used to induce fear of heights, corresponding to the defensive behavior of freezing. In a sample of 98 participants, a freezing response was successfully induced and tracked using both subjective indicators of stress and electrodermal activity (EDA). Additionally, the Stress Silhouette test was used to identify areas of muscular tension in the body; the Questionnaire of Approach and Avoidance Motivation (QAAM) measured stable individual differences in the experience of fear and anxiety; and the Tonic Immobility Scale (TIS) was used to track momentary emotional states during stress induction. Results support the distinction between anxiety and fear: anxiety predicted anticipatory subjective distress and EDA, whereas fear predicted only subjective distress during direct exposure to the stressor. Furthermore, no correlation was found between subjective distress and EDA, and a body map of muscle tension during the freezing experience was explored. The findings of this study are largely consistent with previous research and theoretical expectations and highlight the utility of VR for studying defensive responses in humans.
Food allergy is a chronic condition with psychosocial consequences for both children and their families. Strict elimination diets and fear of adverse reactions may contribute to maladaptive coping including behaviors avoidant/restrictive food intake disorder (ARFID)-related eating patterns. Therefore, this study aimed to compare ARFID-related eating behavior scores between children with food allergy and healthy controls and to identify the affected domains. In this prospective controlled study, 234 children aged 2-9 years were enrolled, including 117 children with physician-diagnosed food allergy and 117 age- and sex-matched healthy controls. Eating behaviors were assessed using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen-Parent Report (NIAS-PR). Total and subscale scores (picky eating, fear, and appetite) were compared between groups. Within the food allergy group, associations between clinical characteristics and NIAS-PR scores were analyzed. Children with food allergy demonstrated significantly higher NIAS-PR total scores compared with controls. The median total NIAS score was higher in the patient group than in the control group (17 [11-24] vs. 12 [7-18], p < .001). This difference was primarily driven by higher fear- and picky-eating-related scores, whereas appetite scores did not differ significantly. Fear subscale scores were significantly higher in children with a history of urticaria or anaphylaxis. Pediatric food allergy is associated with increased ARFID-related eating behaviors, particularly fear- and picky-eating patterns. In addition, fear-related scores were higher among children with a history of immediate-type reactions, such as urticaria and anaphylaxis. These findings suggest that ARFID-related eating behaviors should be considered in the assessment of children with food allergy.
Using a novel behavioral paradigm that integrates fear-potentiated startle (FPS) and prepulse inhibition testing, this study examined how motherhood and infant cues impact innate defensive reactivity (as measured by the magnitude of basal startle reflex), attentional processing (as measured by prepulse inhibition), acquisition, and expression of conditioned fear (as measured by the FPS) in postpartum female rats. Sprague-Dawley mother rats from Postpartum Day 3-9 were tested in this paradigm either in the presence or absence of their own two pups (Experiments 1 and 2), and their performance was compared to virgin female rats and males (Experiment 3). Compared to mother rats tested alone, those tested with their pups being placed inside the apparatus (with no physical contact) showed significantly reduced baseline startle response and reduced overall startle magnitude under the FPS testing procedure. Importantly, this pup-induced reduction of baseline startle and fear startle was only observed in mother rats, not in virgin females or male rats. Notably, pup presence did not alter prepulse inhibition under various testing conditions nor did it affect the acquisition and expression of FPS. Also, postpartum females did not differ from virgin females and males in the acquisition and expression of conditioned fear. Together, these results suggest that distal pup cues may powerfully inhibit defensive reactivity in mother rats, without altering aversive learning or sensorimotor gating ability. The possible behavioral mechanisms involved in this pup effect are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Problematic Smartphone Use (PSU) is a growing concern among adolescents. This cross-sectional study examines the relationship between PSU and psychological distress among Moroccan high school students exploring the mediating effects of Fear of Missing Out (FOMO) and aggression. Participants (N = 2,202) aged 14-23 (M = 16.81, SD = 1.226) were predominantly female (59%) and urban-based (72.5%). Assessments were performed using validated Arabic scales, including the SAS-SV (Smartphone Addiction Scale-Short Version), FoMO, BPAQ-SF (Buss-Perry Aggression Questionnaire-Short Form scale), and DASS-21 (Depression Anxiety and Stress Scale). Beyond the direct impact of psychological distress on PSU, the study revealed an indirect effect through four distinct pathways. The FoMO-Fear dimension had a stronger mediating effect on stress (0.1526, 95% CI: 0.1208 to 0.1865), depression (0.1418, 95% CI: 0.1208 to 0.1865), and anxiety (0.1236, 95% CI: 0.0962 to 0.1548) than the FoMO-Control dimension. The indirect effects through physical aggression were 0.2114 (95% CI: 0.1731 to 0.2540) for stress, 0.1693 (95% CI: 0.1363 to 0.2061) for depression, and 0.1569 (95% CI: 0.1246 to 0.1919) for anxiety, which are all greater than the corresponding effects through anger. These findings underscore targeted mental health support and digital wellness programs to safeguard high school students' well-being.
Nausea and vomiting of pregnancy (NVP) is a common disorder affecting most pregnant women. Previous studies have suggested associations between NVP and psychological pregnancy complications, whereas only a limited number of studies have explored a possible association with fear of childbirth (FOC). Shared biological underlying factors have been proposed, but the precise mechanisms remain poorly understood. The objective of our study was to explore the relationship between NVP and FOC. Pregnant women (n = 2411) were recruited from maternity health care clinics in the Turku area, Finland. The severity of NVP was evaluated with the Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire, and the women were categorized into two groups: the no/mild NVP group (PUQE points 3-6, n = 963) and the moderate/severe NVP group (PUQE points 7-15, n = 1366). Data on FOC (International Statistical Classification of Diseases, 10th Revision [ICD-10] code O99.80) and maternal characteristics (age, body mass index, parity, marital status, employment status, and smoking) were drawn from the Finnish Medical Birth Register. The association between NVP and FOC was evaluated using logistic regression adjusted for maternal characteristics. The data of 2329 women were eligible for the analysis. Compared with the women in the no/mild NVP group, those in the moderate/severe NVP group were more likely to suffer from FOC (OR 1.69, 95% CI 1.11-2.58, p = 0.015). The difference between the groups remained after adjustment for maternal background factors (aOR 1.72, 95% CI 1.09-2.71, p = 0.019). We showed an association between more severe NVP and FOC. The evidence from our study implies that, beyond the physical manifestation, NVP may contribute to psychological distress and influence women's perception of childbirth. These findings highlight the importance of also addressing the psychological aspects of NVP in clinical care.
The ventral tegmental area (VTA) has traditionally been framed as a hub for motivation and positive reinforcement learning. However, growing evidence reveals that the VTA is also deeply embedded in defensive computations. Across glutamatergic, GABAergic, and dopaminergic populations, VTA neurons respond to aversive stimuli and can initiate innate defensive behaviors when manipulated. Here, we synthesize recent advances showing that VTA circuits detect threats, encode aversive salience, and orchestrate responses ranging from freezing and risk assessment to escape and defensive aggression. By integrating findings across cell types and circuits, we propose that the VTA functions as a dynamic threat-computation hub that maps threat imminence onto adaptive action policies. Stress-induced plasticity within VTA microcircuits may recalibrate defensive thresholds, offering a mechanistic bridge to anxiety disorders.
Individuals with knee osteoarthritis (OA) experience both pain and functional limitations which negatively impact quality of life and contribute to years lived with disability. Movement-evoked pain (MEP) is thought to act as a barrier to participation in daily activities, resulting in reduced function. The aim of this study was to examine the relationships between knee-specific measures of self-report pain interference, fear avoidance and performance-based MEP, and their associations with physical function among individuals with knee OA seeking joint arthroplasty. Using baseline data from the Acute to Chronic Pain Signatures Consortium (training data: release 1.0.0, n=603; validation data: release 2.0.0, n=441), this cross-sectional study employed structural equation modeling to examine associations among self-reported pain, movement-evoked pain, and physical function. We further evaluated whether these relationships differed by task specificity and biological sex. Greater self-reported knee pain interference and higher fear avoidance were associated with poorer physical function (β=-0.83, P<0.001). In contrast to expectations, MEP showed little association with physical function (β=-0.11, P=0.072) and was weakly associated with self-report knee pain interference and fear avoidance (β=0.36, P<0.001). These patterns were consistent in a validation dataset. These findings suggest knee-specific self-report measures (pain, pain interference, fear avoidance) and performance-based MEP are unique constructs. Self-report measures of knee pain interference and fear avoidance were more strongly related to the functional limitations in knee OA compared to performance-based MEP.
 Nursing students face significant academic and clinical stressors that can affect their psychological well-being. These challenges are intensified during extraordinary events, such as the coronavirus disease 2019 (COVID-19) pandemic.  This study investigated psychological distress and resilience among junior (1st year - 2nd year) and senior (3rd year - 4th year) undergraduate nursing students exposed to a major stressor at two universities in the Western Cape, South Africa.  A survey was conducted among 589 nursing students during and after COVID-19. Most respondents were female (77.4%) and junior students (75.2%), with a mean age of 22.5 years (± 4.6). Data collection took place at University A (February 2021-March 2021) and University B (November 2021-February 2022). Measures include psychological distress (Kessler-10), resilience (Response to Stressful Experiences Scale) and fear of COVID-19 (Fear of COVID-19 Scale).  Overall, students reported mild psychological distress and fear of COVID-19, and high levels of resilience. Senior students experienced significantly higher psychological distress than juniors (p  0.001), but lower fear of COVID-19 (p = 0.028). Resilience did not differ significantly between groups, with most students demonstrating high resilience.  Nursing students showed strong resilience despite the added pandemic-related stressors. Elevated distress among seniors, however, highlights the need for targeted psychological support. Strengthening resilience within nursing education may prepare students to manage future crises and contribute to a sustainable, adaptable nursing workforce.Contribution: This study provides evidence on the psychological well-being of nursing students in South Africa during the COVID-19 pandemic. It emphasises the importance of resilience-building interventions within nursing curricula and institutional support systems to safeguard student health and professional readiness.
Identifying predictors and mechanisms in the development of childhood internalizing (INT) and externalizing (EXT) problems is crucial for early intervention. Inhibitory control has been linked to INT and EXT, with emotion regulation (ER) potentially mediating these associations. However, specific pathways between early inhibitory control, ER, and later INT and EXT remain unclear. Additionally, regulation of distinct emotions (anger, fear, sadness, joy) may play a role. The sample included 94 typically developing children from the EFFECT study, a longitudinal project on the development of self-regulation. At age 4, inhibitory control was measured using the Day/Night Stroop Task. At age 6, general ER, as well as regulation of specific emotions (anger, fear, sadness, and joy), were assessed using the Emotion Questionnaire (parent-report). INT and EXT at ages 9-10 were measured using the Strengths and Difficulties Questionnaire (parent-report). Correlational and path analyses were conducted. No longitudinal associations were found between inhibitory control at 4 years and either INT or EXT at ages 9-10, or with ER at age 6. Consequently, we found no evidence of mediation by ER. General ER at 6 years emerged as a predictor of both INT and EXT at 9-10 years. While not statistically significant, effect sizes linking regulation of some specific emotions (anger, fear) with subsequent INT and EXT problems warrant further research. The results reflect the complexity of studying longitudinal effects of early inhibitory control. A modest sample size with attrition, and measurement constraints may have attenuated effects and limited generalizability. Meanwhile, our findings highlight ER as a target for intervention across both INT and EXT.
This multi-center, cross-sectional study investigated death attitudes and death anxiety among nursing interns in China, explored their internal correlations, and identified independent predictors of high death anxiety to provide an empirical basis for enhancing death education and end-of-life care quality. A survey was conducted among 400 nursing interns from four medical institutions using an online platform. Validated instruments included the Death Attitude Profile-Revised (DAP-R) and the Chinese Version of the Templer Death Anxiety Scale (CT-DAS). High death anxiety was defined as a CT-DAS score > 35. Multivariate logistic regression was employed to identify factors significantly associated with death anxiety. Of the participants, 27.5% were classified as having high death anxiety. Correlation analysis revealed that natural acceptance was negatively associated with death anxiety (r = -0.252, P < 0.001), while fear of death (r = 0.508), death avoidance (r = 0.274), approach acceptance (r = 0.200), and escape acceptance (r = 0.225) showed significant positive correlations (all P < 0.001). Multivariate analysis identified female gender as a significant risk factor (OR = 4.17, 95% CI: 1.45-12.02, P = 0.008). Fear of death (OR = 1.39, 95% CI: 1.26-1.54, P < 0.001), approach acceptance (OR = 0.90, 95% CI: 0.84-0.96, P = 0.002)and escape acceptance (OR = 1.16, 95% CI: 1.05-1.28, P = 0.003) were associated with death anxiety. Nursing interns in China exhibit a relatively high prevalence of death anxiety, which is closely linked to gender, clinical knowledge, and cognitive orientations toward death. Higher levels of fear of death and escape acceptance are associated with increased death anxiety, whereas approach acceptance appears to be protective. It is imperative to integrate structured, experiential death education into nursing curricula to enhance interns' psychological resilience and improve the delivery of end-of-life care. Not applicable.
In clinical practice, a significant subgroup of patients with moderate-to-severe asthma reports persistent symptoms and substantial impairment in daily functioning despite high adherence to prescribed inhaled therapy. However, their lived experiences and unmet needs remain poorly understood. This descriptive phenomenological study aimed to explore the illness experiences, related barriers, and unmet needs of adults with moderate-to-severe asthma who remained persistently uncontrolled despite objectively verified high adherence to prescribed inhaled maintenance therapy. In-depth, semi-structured interviews were conducted with 14 adult patients between June and November 2025 in a specialty asthma clinic at a tertiary-level hospital in China, and the data were analyzed using Colaizzi's seven-step phenomenological method. Four overarching themes were identified, revealing a multidimensional hidden burden: (1) physiological instability, characterized by persistent symptoms and comorbidity-driven symptom amplification; (2) life-space constriction, involving occupational vulnerability, stigma, and defensive withdrawal; (3) psychological duality, in which fear and vigilance coexisted with resigned habituation; and (4) therapeutic dilemmas, including corticosteroid anxiety and dependence, financial toxicity, and fears of therapeutic futility. These findings show that persistent poor control in highly adherent patients is experienced not simply as ongoing symptoms, but as a multidimensional burden. This adherence paradox challenges the assumption that high adherence invariably indicates satisfactory control. The findings also highlight the need for nurse-led follow-up and future intervention studies focusing on symptom interpretation, uncertainty management, and treatment-related concerns in this subgroup.
The psychological conditions under which hormonal response profiles predict later distress remain unclear. The present study tested whether subjective distress during a biological stressor moderates the association between testosterone-cortisol coupling and responses to subsequent psychosocial stress. Participants completed a 35% CO₂ Challenge and, a few days later, the Trier Social Stress Test (TSST). Analyses included 115 males and 49 females with hormonal and subjective distress data collected during the stress protocols. Hormonal and subjective responses were quantified using area under the curve with respect to ground (AUCG), and separate regression analyses were conducted for males and females. Significant interactions between CO₂ Challenge-evoked testosterone, cortisol, and subjective distress emerged for TSST stress in males and females, and TSST fear in males. In males, the dual-hormone hypothesis pattern of higher testosterone coupled with lower cortisol during the CO₂ Challenge predicted higher TSST stress and fear when CO₂ Challenge distress was average or higher. These findings suggest the emotional significance of testosterone-cortisol coupling may depend, in part, on whether the initial stressor is experienced as distressing.
Emerging research suggests those with food allergy may have a higher risk of eating and feeding disorders; however, data on the prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) among individuals with food allergy is limited. We examined whether possible ARFID in 10-year-old children was more common in children with or without food allergy. The HealthNuts study recruited 5276 one-year-olds across Melbourne, Australia who were followed-up at ages 4, 6, and 10 years. Food allergy was assessed at each age with skin prick tests, clinical history, and/or oral food challenges. The Food Allergy Quality of Life Parent Form (FAQLQ-PF) capturing food allergy anxiety was completed for those with suspected food allergy. The ARFID assessment tool 'Eating Disorders in Youth Questionnaire (EDY-Q)' was completed by children participating in their age 10 assessment after 10 April 2019. A total of 951 children completed the EDY-Q, of whom 102 had a current food allergy. The prevalence of possible ARFID was similar among children with current food allergy, 23% (95% CI 15-32) compared to without, 21% (95% CI 18-24). When considering food allergy anxiety (reported on FAQLQ-PF) as a symptom of possible ARFID (a variant not captured by EDY-Q), an additional 10 children (of 102) with food allergy may meet the criteria for possible ARFID but were missed by the EDY-Q. A similar proportion of children with and without food allergy were identified by the EDY-Q of being at risk of ARFID. The EDY-Q may lack sensitivity to detect ARFID in individuals with food allergy as it does not capture fear of allergic reactions. Newer ARFID tools incorporating fear of allergic reactions have since become available. Future research using these tools may provide more precise prevalence estimates among individuals with food allergy.
Clinical guidelines consistently recommend low-impact physical activity (PA) for the management of hip or knee osteoarthritis (OA). This study aimed to determine the risk and mediators of joint replacement in people with hip or knee OA who participate in high-impact PA. We conducted a mediation analysis using data from the Good Life with osteoArthritis in Denmark (GLA:D) registry. Baseline PA was self-reported using the University of California, Los Angeles (UCLA) Activity Scale and categorised as high-impact, high-intensity, moderate-intensity or low-intensity. Outcomes were self-reported total hip replacement (THR) or total knee replacement (TKR) at 12 months. Candidate mediators measured at 3 months were joint pain intensity, functional capacity (30-second chair stand test) and fear of joint damage from PA. Among 5911 participants with hip OA (66.8 years, 69.5% women), 5.9% engaged in high-impact PA. Among 11 750 participants with knee OA (66.5 years, 72.7% women), 5.2% engaged in high-impact PA. High-impact PA was associated with 36-48% lower odds of THR and was not associated with altered risk of TKR. There was little evidence that pain intensity, functional capacity or fear of joint damage mediated these associations. However, a small indirect effect via functional capacity was observed, where a greater functional capacity was associated with a reduction in odds of TKR (OR 0.92, 95% CI 0.87 to 0.98). High-impact PA was associated with a substantially lower risk of THR, and did not increase TKR risk. Clinicians may consider recommending higher-impact activities for individuals with hip OA, and supporting continued participation in knee OA when symptoms, capacity and patient goals allow.
Suicide claims over 720,000 lives annually worldwide and for every suicide there are many more people who attempt suicide and with suicidal ideation being even more prevalent. To improve the identification of individuals at high risk for suicidal behavior, there is a need to study risk factors in relation to neurobiological mechanisms. This paper proposes an integrative neurobiological hypothesis linking childhood adversity as a known risk factor for suicide attempts and the experience of mental pain in individuals with childhood adversity in their background. The ideation-to-action theory proposes that psychological pain, in addition to hopelessness, is associated with suicide ideation, whereas the acquired capability to attempt suicide enables the progression from suicidal thought to suicidal behavior. A psychological paradox is suggested wherein childhood adversity exposed individuals are more vulnerable for psychological pain, a driver for suicidal ideation, alongside increased physical pain tolerance and fearlessness about death fostering suicide capability. Pain perception may be neurobiologically regulated. Dysregulation of the purinergic pathway and purinergic receptors, such as overactivation of the P2X7 receptor, may contribute to suicidality through at least three parallel mechanisms: neuroinflammation via NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome activation, glutamatergic dysregulation in the anterior cingulate cortex, and disruption of inhibitory pain and fear circuits via brain-derived neurotrophic factor (BDNF) -mediated potassium chloride cotransporter 2 (KCC2) downregulation. Purinergic dysregulation is associated with increased risk for suicidal behavior, which has been demonstrated in bipolar and depressive disorders and schizophrenia. Converging evidence from genetic studies, peripheral inflammatory biomarkers, and postmortem brain tissue indicates that P2X7 dysregulation in suicidality is cell-type and region-specific, with the most direct evidence coming from postmortem findings in individuals who died by suicide independent of psychiatric diagnosis. These neurobiological changes may lower barriers to suicidal behavior during acute crises. In vivo PET with [11C]SMW139 or [11C]JNJ717 can visualize the purinergic pathway through high-affinity binding to the P2X7 receptor. We hypothesize that in vivo receptor overactivation is associated with acute suicidality, hence psychological pain. This approach offers potential for biomarker development and targeted therapeutic interventions addressing the neuro-immune substrate of suicidality.
Age-related declines in neuromuscular and sensory systems substantially increase fall risk and impair independence in older adults. Exercise interventions improve balance and gait; however, the maintenance of these training-induced gains over time remains uncertain, as most benefits may diminish within months after training ceases. This study determined whether an 8-week Dynamic Neuromuscular Stabilization (DNS) programme produces post-intervention and short-term follow-up improvements in balance, gait speed, fear of falling, and health-related quality of life in community-dwelling older adults. In this assessor-blinded randomised controlled trial, 44 older adults aged 60-75 years were randomly allocated to either supervised DNS (totaling 24 sessions: three sessions per week for 8 weeks, 40-50 min per session) or a usual-activity control group. Outcomes were measured at baseline, immediately post-intervention, and at 2-month follow-up using validated clinical instruments. Thirty-nine participants completed the trial (DNS group, n = 19; control group, n = 20). Mixed-design ANOVA showed significant group × time interactions for all outcomes (all P < 0.001). At post-test, the DNS group exhibited large effect-size improvements compared with controls: static balance errors decreased by 58-74% (Cohen's d = 2-2.65), dynamic balance scores increased by 36% (d = 2.05), gait speed increased by 28% (d = 1.54), fear of falling decreased by 42% (d = 1.92), and physical and mental health-related quality of life (HRQOL) components improved substantially (d = 2.20-2.28). At 2-month follow-up, these improvements were largely maintained without significant deterioration within the follow-up period (P > 0.05). The control group exhibited no meaningful changes. An 8-week DNS intervention yields robust, clinically meaningful, and sustained short-term improvements across multiple domains related to fall risk in older adults. These short-term retained adaptations position DNS as an effective neurophysiologically based approach for fall prevention within the observed follow-up period.Trial registration: RTC, prospectively registered in the Clinical Trial Registry (UMIN000055127) on 29/12/2024.
Most research on dieting behaviours has examined rigid dieting, characterised by strict, rule-bound approaches to eating that reflect an all-or-nothing mindset. However, this work has primarily emphasised behavioural features, with comparatively less attention to the cognitive and emotional processes underlying rigid control. Inflexible eating has recently been proposed as a specific construct capturing psychological inflexibility in the domain of eating, including rigid adherence to self-imposed rules and distress when these are violated. While conceptually related to rigid restraint, inflexible eating extends beyond traditional behavioural conceptualisations by incorporating these psychological processes. Despite its relevance, prospective evidence on its predictors remains limited. This study examined whether baseline body image facets (body dissatisfaction, fear of weight gain, overvaluation, and preoccupation), disordered eating behaviours (binge eating, driven exercise, and muscularity-oriented disordered eating [MODE]), and psychological functioning (depressive and anxiety symptoms) prospectively predicted inflexible eating. A total of 1760 women (M = 34.00 years, SD = 9.40; 81.3% White) completed measures at Time 1 (T1), with 1237 providing 3-month follow-up data (Time 2; T2). Bivariate analyses showed that all T1 body image facets, poor psychological functioning, and disordered eating behaviours except binge eating predicted higher T2 inflexible eating. In multivariate analyses, T1 fear of weight gain, MODE, and depressive symptoms uniquely predicted greater T2 inflexible eating. Findings identify key psychological and behavioural precursors of inflexible eating, underscoring potential targets for early intervention and prevention.